Kids Dental Space, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KIDS DENTAL SPACE, LLC

Practice address

7402 York Rd Ste 204
Towson, MD 21204-7520

Phone

(301) 537-5536

NPI assigned

Apr 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roxanne Patreace Clarke, DDS

Title

Pediatric Dentist/Owner

Phone

(301) 537-5536

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648857600000",
    "number": "1932840220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8617 GOLDENWOOD RD",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212372032",
            "telephone_number": "301-537-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7402 YORK RD STE 204",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212047520",
            "telephone_number": "301-537-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTAL SPACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-02",
        "last_updated": "2022-04-02",
        "certification_date": "2022-04-02",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_middle_name": "PATREACE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST/OWNER",
        "authorized_official_telephone_number": "301-537-5536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046568200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1326279829",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Towson, MD
• Providers in Towson, MD by specialty
• Pediatric Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.